Dry, crusty nose? It could be Atrophic Rhinitis

Many people notice their nose feels dry and clogged with crusty lumps, especially after being in dusty or dry places, but few realize this could signal something more serious. What they don’t know is that the lining of the nose can actually thin out over time, leading to a condition called atrophic rhinitis.

“Atrophic rhinitis is a chronic inflammation of the nose, leading to a progressive loss of the nasal mucosa and turbinate bones,” explains Joseph Kioko, an Ear, Nose and Throat (ENT) clinician. This thinning not only causes crusting but can also result in dryness, irritation and a bad smell.

The World Health Organization (WHO) points out that causes range from infections to environmental factors, and without treatment, the discomfort can worsen over time.

Atrophic rhinitis is more common in developing countries, particularly in parts of Africa and Asia, where environmental and socioeconomic factors may increase the risk. Kioko explains, “The condition tends to affect females more than males, and its prevalence increases with age.”

Globally, studies estimate it affects 0.3-1 per cent of the population in some regions. While data in Kenya is limited, the condition is likely under-reported, especially in rural areas where access to healthcare is a challenge.

The exact cause of atrophic rhinitis is not always known (idiopathic), but several factors may play a role in its development.

Kioko explains, “Theories suggest hereditary factors, hormonal changes starting at puberty that tend to affect females more and even racial differences, with white races being more affected than natives of equatorial Africa.”

A lack of important nutrients, like vitamins A, D or iron, may also contribute to the development of atrophic rhinitis. Additionally, infections and autoimmune processes have been linked to the condition.

According to the WHO, environmental and socioeconomic factors can exacerbate these causes, particularly in developing regions.

Symptoms

Atrophic rhinitis presents with various signs and symptoms that can impact daily life. Common symptoms include nasal obstruction, foul-smelling nasal discharge and nosebleeds (epistaxis).

Kioko notes that patients may also experience crusts in the nasal cavity, a roomy nasal cavity and pale nasal mucosa.

Additionally, the American Academy of Otolaryngology-Head and Neck Surgery reports that individuals with atrophic rhinitis may suffer from loss of smell, frequent upper respiratory infections, sore throat, watery eyes and headaches. In tropical regions, some cases have even involved maggots living inside the nose due to the strong odour attracting flies.

Atrophic rhinitis is divided into two main types: primary and secondary. Primary atrophic rhinitis, which has no clear cause, is the more common type. Secondary atrophic rhinitis, on the other hand, results from factors like nasal surgeries, granulomatous diseases, malignancy or radiation exposure. This type is more frequently observed in industrialized nations. The primary form remains the most common globally, especially in areas with limited access to healthcare.

Prevention of atrophic rhinitis involves maintaining a balanced diet and ensuring the early and correct management of nasal infections. “A balanced diet is essential for overall health, and managing nasal infections correctly can prevent further complications,” Kioko advises. It’s also important to avoid environmental factors that could irritate the nasal lining.

Symptoms

Kioko recommends seeking medical advice if symptoms like nasal obstruction or foul-smelling discharge appear, as atrophic rhinitis may require either medical or surgical intervention. “It’s crucial to seek professional treatment, as improper self-treatment can lead to complications and more severe suffering,” he warns.

Although home remedies may seem tempting, Kioko cautions that self-treatment can be risky, as other conditions may appear similar to atrophic rhinitis.

Atrophic rhinitis can lead to several complications if not properly managed. Kioko notes that these include “saddle nose deformity (a loss of the shape of the nose), septal perforation (a hole in the nasal septum), secondary rhinosinusitis (infection of the sinuses) and systemic spread to areas such as the pharynx and larynx.”

The WHO highlights that “older age, poor nutrition resulting in iron or vitamin deficiency and insufficient hydration” are major risk factors for developing atrophic rhinitis. Additionally, Kioko points out that “medical conditions including Sjogren’s syndrome and autoimmune diseases” can increase the risk.

Understanding the causes, symptoms and risk factors helps in managing and preventing atrophic rhinitis effectively.